Evergreen Eligibility Form.docCOMMUNITY PRESERVATION ELIGIBILITY DETERMINATION FORM
The purpose of this form is to make sure that all project applications applying for Community Preservation Act funding are eligible for funding. Please refer to Appendix-E in the Community
Preservation Plan when filling out this form. This form must be approved in order for an application to be accepted.
Project Title: Evergreen Road Affordable Housing
Project Sponsor/Organization: Northampton Office of Planning & Sustainability
Contact Name: Carolyn Misch, Director of Planning and Sustainability
Property Owner, if applicable: N/A
Mailing Address: 210 Main Street, Room 11, Northampton MA 01060
Daytime phone #: 413-587-1287
Fax #: 413-587-1264
E-mail address: cmisch@northamptonma.gov
CPA Program Area (check those that apply):
� Open Space � Historic Preservation
X Community Housing � Recreation
Project Purpose (check those that apply):
� Acquisition X Creation � Preservation
� Support � Rehabilitation/Restoration
Project Summary: Please provide a brief description of the project.
CPA funds will be used to contribute to building costs for a new affordable housing unit(s).
For CPC Use Eligible: _____ Not Eligible: _____ Date: __________ Reviewer: ____________________